Category: ADHD

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Your child’s ADHD diagnosis could be wrong, leaving other issues untreated

Inattention and distractibility are caused by many medical conditions and life situations.  You child may not have ADHD or ADD if they didn’t show signs when they were young.

Children don’t just catch ADHD or ADD

If your child has a behavioral change you haven’t seen before, there may be an underlying medical or co-occurring mental disorder that’s causing ADHD symptoms… especially if they’re on ADHD-ADD medications which are not working well.

“It is vital not to mistake another medical or psychiatric condition as ADHD.”
Richa Bhatia, MD, Fellow of the American Psychiatric Association

The medical conditions listed below produce ADHD and/or ADD symptoms such as slow processing speed, impulsive behavior, and limited attention and focus.

  • Epileptic seizures: some types cause a brief freeze in thinking–the child’s brain goes blank for a few moments (“absence seizures”)
  • Diseases of the brain: Lyme disease, HIV infection, parasitic and viral infections, brain tumors
  • Brain damage from head injury or toxins (e.g. narcotics)
  • Chemotherapy side-effects, “stupor”
  • Hypothyroidism.  Too little thyroid hormone results in memory, attention, and concentration problems. It decreases blood flow in brain regions that mediate attention and executive functioning (the hippocampus and cerebral cortexes).
  • Hyperthyroidism. At the other extreme, too much thyroid hormone causes anxiety and tension, irritability and impatience, and hyperactivity and distraction.
  • Sleep apnea. A condition where a child stops breathing during sleep, for a few seconds to a few minutes several times per night.  The following day, the child can’t pay attention, remember, or follow a sequence of steps.  It also causes hyperactivity and belligerence.


Mental health disorders with ADHD-like symptoms:

Anxiety disorders are common to most other mental health conditions, and create problems with concentration.  The chronic stress from anxiety affects the brain regions responsible for memory and cognitive functions.   If a child does not have a history of ADHD symptoms, than significant and pervasive anxiety may be the cause of inattention and distraction.

Abuse or trauma. Difficulty concentrating is one of the core symptoms of post-traumatic stress disorder (PTSD), and recent abuse or trauma can cause agitation, restlessness, and behavioral disturbance—symptoms that mimic ADHD.

Depression – Difficulty concentrating also is a criterion for major depressive disorder.

Bipolar disorder – ADHD symptoms are apparent in children with suspected bipolar disorder. Both disorders can cause distractibility, increased energy, and instant mood swings. (Some children are eventually diagnosed with both disorders.)

Drug abuse using marijuana, cocaine, ecstasy, produce similar symptoms of ADHD because they affect the same brain regions affected by anxiety.  MRI scans of the brain were taken of young children who were exposed to cocaine in the womb. The scans revealed frontal lobe malformations which predicted long-term problems with attention and impulse control.

Common stimulant foods and beverages with excess caffeine or sugar

Insomnia from medical conditions. Sleep plays a huge role in memory and attention. Sleep disorders (e.g., sleep apnea, restless legs syndrome) can produce chronic tiredness and significantly reduce attention, concentration, and cognitive functioning in children, adolescents, and adults.

Plain old lack of sleep in healthy children can cause inattention and reduce academic achievement.  There are many causes of sleep loss:  early school hours; screen time at least an hour before bed (because the blue light suppresses sleepiness); or allowing the use of technology in the bedroom at nighttime.  What helps getting to sleep and staying asleep:

  • A cool, dark room
  • Thirty minutes of reading or drawing on paper before lights out.
  • Removing phones, laptops, or desktops from the bedroom at night.


Learning disorders:
Children with an undiagnosed learning disorder often present with ADHD symptoms. An undiagnosed reading or mathematics disorder (dyslexia), or an autism spectrum disorder that’s not yet diagnosed, can have a significant impact on classroom behavior.  The child might not be paying attention because of his (her) restricted ability to grasp the subject matter, or because they are frustrated and irritated with the struggle to keep up.

Caution:  Teachers often report a student’s inattention and confused thinking to parents, and suggest a diagnosis of ADHD when the real problem may be lack of sleep or something else.  It’s useful to hear classroom observations of your child, but teachers are not trained in mental health diagnosis—get a second opinion from a professional!

More on the consequences of untreated ADHD or another underlying disorder is in this article:  “ADHD kids become troubled adults.”

–Margaret


Subject matter was drawn from this article by psychiatrist Dr. Richa Bhatia.

“Rule out these causes of inattention before diagnosing ADHD”
Richa Bhatia, MD, FAPA, Current Psychiatry. 2016 October; 15(10):32-C3

Mental Health Medications for Children ages 3 – 12

Mental Health Medications for Children ages 3 – 12

This is an excerpt from an article contributed by Drugwatch, an organization devoted to informing the public about the uses and risks of drugs and medications, and the use of medical devices.

Doctors may prescribe the use of medications to treat the health effects of bullying.

For example, children who suffer from depression or anxiety disorders (two health effects of bullying) may be prescribed selective serotonin reuptake inhibitors (SSRIs), such as Prozac. It’s important for parents to be aware that all SSRIs carry risks.

Childhood Bullying & Its Health Effects

Research shows that bullying behavior can start as early as age 3. Both children who are bullied and those who bully others may have serious lasting health problems as a result of these actions.

Bullying may cause lasting health issues for both parties involved.

A 2017 study by University of Pittsburgh researchers, for example, found that children who are bullied experience mental and physical health issues that can last well into adulthood. The study shows that bullied children are more likely to have trouble with finances and to be treated unfairly by others. They are also more pessimistic about their futures, according to the study.

On the other hand, the study revealed bullies are more likely to be stressed, hostile and aggressive, and to smoke cigarettes and marijuana. Both bullies and their victims are at a higher risk of heart disease, which is the leading cause of death for both men and women.

Doctors may prescribe Cymbalta to treat generalized anxiety disorder in children ages 7 to 17.Childhood developmental or learning disorders are often diagnosed when a child is of school-age. Mental illnesses, however, can be hard for a parent to identify. Although children can develop the same mental health conditions as adults, they sometimes express them in different ways. In 2013 alone, more than 8.3 million children were taking psychiatric medications. About half of the medicated children were between the ages of 6 and 12.

ANXIETY DISORDERS

Anxiety disorders are a group of mental disorders branded by feelings of anxiety and fear. Children may have more than one anxiety disorder. More than 2 million children were on anti-anxiety medications in 2013. The age group with the largest number of medicated children was ages 6 to 12 years.

Generalized Anxiety Disorder (GAD)

It’s perfectly normal for your child to stress about grades or an upcoming sporting event. However, if your child worries excessively or if anxiety and fear affect your child’s ability to perform daily activities, your child may be suffering from GAD. Doctors may prescribe Cymbalta, a serotonin-norepinephrine reuptake inhibitor (SNRI) as treatment. In 2014, the FDA approved Cymbalta for the treatment of generalized anxiety disorder in children ages 7 to 17. SNRI medications carry serious risks, including birth defects, skin disease, suicidal thoughts and liver toxicity. The FDA also warns of Cymbalta discontinuation syndrome, which is when a person experiences withdrawal side effects after stopping Cymbalta. Effexor, another SNRI, has not been approved by the FDA for use in children, but some doctors prescribe it for older teens as an off-label treatment for depression and anxiety.

Obsessive Compulsive Disorder (OCD)

Prozac, Zoloft and Luvox are among the drugs used to treat OCD in children.

Children with OCD experience unwanted and intrusive thoughts — or obsessions. They feel compelled to repeat rituals and routines to try to lessen their anxiety. OCD can affect children as young as 2 or 3, though most children with OCD are diagnosed around age 10. The FDA has approved several drugs to help control the symptoms of OCD in children, including Prozac, Zoloft and Luvox.

The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.

Tourette Syndrome

Children with Tourette syndrome may make unusual movements or sounds known as tics. The FDA has approved haloperidol, pimozide and aripiprazole to treat tics.  All three medications have the potential to cause unwanted side effects, so most doctors prescribe the blood pressure medications guanfacine or clonidine. This is known as “off-label” use because the FDA has not approved either drug for treatment of tics.

MOOD DISORDERS

Every child can feel sad or depressed at times, but mood disorders are more extreme and harder to manage than typical sadness. Doctors may prescribe antidepressants or antipsychotics to treat mood disorders in children. SSRIs are popular antidepressants, despite an increased risk of suicidal thoughts in children. Prozac is the only SSRI approved for use in children older than 8 years of age. Antipsychotics prescribed to children include Abilify (aripiprazole), Thorazine (chlorpromazine), Risperdal (risperidone) and Invega (paliperidone).

These new kinds of drugs called atypical antipsychotics can have serious side effects in children like drastic weight gain, sedation and movement disorders. Risperdal and Invega also include a side effect called gynecomastia, a condition where boys develop breasts.

Nearly 2.2 million children were on antidepressants in 2013, and more than 830,000 were taking antipsychotics. In addition, doctors often prescribe the anti-seizure drug Depakote for children with bipolar disorder, a use not approved by the FDA. The medication has a black box warning for increased risk of liver failure and pancreatitis in children and adults.

(Blog owner’s note: Antidepressants are sometimes mistakenly prescribed to depressed children who are actually experiencing the depressed phase of bipolar disorder. The risk is that antidepressants can bump a child’s mood way too high, into mania.)

ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)

Doctors use stimulants like Ritalin and Adderall to treat ADHD.

Doctors have been diagnosing children as young as 4 with ADHD. In the past nearly 30 years, the number of children diagnosed with ADHD has grown six-fold. Scientists estimate about 5 percent of children actually have ADHD, but the CDC shows that 15 percent are diagnosed.

Doctors usually treat children with ADHD with stimulants such as Ritalin (methylphenidate) and Adderall (amphetamine and dextroamphetamine). Side effects of these drugs include decreased appetite, sleeping problems and headaches. Less common but more severe side effects include the development of tics and personality changes. Data from 2013 showed more than 4.4 million children were on ADHD drugs.

Children with a history of heart conditions may have a higher risk of strokes, heart attacks and sudden death when taking stimulants. Studies have also found rare cases of children developing hallucinations – such as hearing voices and increased suspicion without reason – or becoming manic.

Children & Medications

Children are particularly vulnerable to the potentially harmful side effects of drugs during important stages of physical and mental development. The amount of mental health drugs prescribed to youth has increased at an alarming rate, and each comes with its own risk.

AUTHOR

Emily Miller
emiller@drugwatch.com
407-955-4198

 

This is the full article from which the above post is excerpted:
“Children’s Comprehensive Health Guide – From Newborn to Preteen”

 

Take this parenting skills test if you have a troubled child

Take this parenting skills test if you have a troubled child

So how are you doing in your difficult parenting job?  Score your parenting skills on a test designed for parents of children ages 11-15.  This is intended for parents of ‘normal’ children, so you may skip 5, 6, and 7. (If you are brave, have someone else score you too and compare results.)

Parenting Skills Test – printable form

Don’t be hard on yourself if you score low.  Only a “perfect” parent will have an excellent score… and they wouldn’t need to read this blog!

What did you learn?  What are the skills where you scored lowest?  Focus on them.  Troubled kids need to be parented differently.  What you’ve learned by watching skilled parents may not apply to you.  You might be thinking:  “I agree these are good parenting skills, but practicing them is impossible with my child. They hate/defy/scream/fill-in-the-blank constantly.” Suggestion:  Work on one skill at a time, and take the test again in few weeks to see if you’ve improved your score. 

Be and kind forgiving of yourself if you score low

When my child was young and I was stressed, I would have had a low score and fallen in the “Keep trying” group.  My child’s mental health so poor, and she was so at-risk, I could only focus on safety and live one day at a time.

Why 3 of the items don’t apply for parents with mentally ill children, IMHO

#5  “I let natural consequences do the teaching whenever feasible.”  In my case, natural consequences could always be serious and unsafe.  This would have been very unwise.
#6  “I am confident my child has everything she/he needs to make good decisions.”  No way.  They cannot make good decisions when they are irrational–that’s the problem.
#7  “I allow my child to do his/her chores without reminding.”  I gave up on chores.  It was one battle I didn’t have to fight.  It was much easier doing them myself and knowing they’d be done.

Please add a comment if you have found other skills to be effective,

–Margaret

Understanding and supporting a child with ADD or ADHD

Understanding and supporting a child with ADD or ADHD

Boy-with-ADD

This article contributed by the Diamond Ranch Academy.

Life with a child with ADD or ADHD can be trying and overwhelming. However, as a parent there are practical measures you can take to effectively control and minimize your child’s symptoms without controlling and monitoring their every move.

You help your child overcome daily challenges by redirecting his or her energy into positive activities. You start by having a dialogue with your child and family that honestly communicates the situation in a way that does not accuse them of being “bad”.  Their behavior needs improvement, but speak as if it’s a ‘normal’ problem that must be addressed.

Children with ADD or ADHD typically have shortcomings in executive function: the ability to think and plan ahead, organize, control impulses, and complete tasks. This means that you need to take over as the executive, providing extra direction while your child progressively obtains executive skills of his or her own. With tolerance, kindness, and plenty of family teamwork, you can help your child manage childhood ADD or ADHD and maintain a steady, happy home

You must to be able to master a combination of support and predictability.

Living in a home that provides love and lots of structure is the best thing for a child or teenager who is learning to manage ADD/ADHD. There are effective and simple changes you can make that are easy to implement; we offer four practical tips to help you understand and support your child with ADD or ADHD:

1.  Be honest with your child about ADD or ADHD
distracted girlIt is important not to avoid or ignore your child’s condition. ADD or ADHD is not your child’s fault, it is a brain disorder that causes young people to have trouble focusing, completing tasks, or planning the future. Most parents can reframe things, but don’t look at the negative. Your child should understand it is something they can and should manage. The rest of your family should do this too.

2.  Stay Positive
dad-and-sonWhen calm and focused, you are more likely to get your child’s attention and help him or her to be peaceful and attentive. And keep things in perspective. Your child’s behavior is related to a disorder, so most of the time it is not deliberate. Don’t sweat the small stuff; be willing to negotiate certain matters. For example, if one chore is left undone but your child has already completed two chores and their homework for the day, let it go and appreciate what they were able to complete. Staying positive also means believing and trusting your child. Trust that your child will learn, change, mature, and succeed.  Trust that your child wants to!

Taking care of yourself will allow you to take better care of your child.

It is vital to live a full, healthy life because you are the child’s role model and source of strength. Eat right, exercise, and find ways to reduce stress. Getting involved with organizations related to ADD or ADHD will also provide you with safe places to vent your frustrations and share experiences.

3.  Establish structure, enforce rules and consequences calmly

boy and garden

Help your child with ADD or ADHD to stay attentive and prepared by setting a strict routine. Set a time and place for everything to help your child with ADD or ADHD comprehend and meet expectations. Allow extra time for what your child needs to do, such as homework, chores, and getting ready in the morning.  Keep them busy but not too busy—a child with ADD or ADHD will become more distracted and act up if there are too many after-school activities going on.

Create structure in your home so your child knows what to expect and when.

Children with ADHD are more likely to succeed if they can complete tasks when the tasks occur in probable patterns and in foreseeable places. Children with ADHD need rules because it helps them track time and progress. Make the behavior rules simple and clear. Write down the rules and hang them up in a place where your child can read them. Children with ADD or ADHD respond exceptionally well to prearranged systems of rewards and consequences. It’s important to explain what will happen when the rules are obeyed and when they are broken. Finally, stick to your system by following through each and every time with a reward or a consequence.

4.  Encourage movement and sleep

teenstalkingChildren with ADD or ADHD often have a lot of energy to burn. Organized sports and other physical activities can help them get their energy out in healthy ways, and refine their focus while enjoying the development of new skills and abilities. Exercise leads to better sleep with children with ADD or ADHD, which also reduces symptoms of ADD or ADHD. Children with ADD or ADHD often find “white noise” to be calming when sleeping. You can create white noise by putting a radio on static or running an electric fan, for example.

Guest Post by: Diamond Ranch Academy
Diamond Ranch Academy is one of the premier youth residential treatment centers for struggling teens. Since 1999, the highly trained staff at this facility has provided guidance and support for teens with varying emotional and behavioral issues including; substance abuse, depression, ADHD, impulse control, peer pressure, anger management, oppositional defiance, self-esteem, grief/loss issues, family relationships, communication, and academic struggles.

Note from blog owner, I am not personally familiar with Diamond Ranch Academy and this post is not an endorsement, but this post offers good information for any parent of a child with ADD or ADHD.  For ideas on what to look for in a good residential program, see the post Residential treatment checklist

–Margaret

Faith can help, and harm, a family’s mental health

Faith can help, and harm, a family’s mental health

When faith helps

Most of the time, people can heal and find peace and self-acceptance through faith. All the world’s great faiths, those that have lasted centuries, are kept alive for this reason. All have common themes of healing and service to others. When things go poorly, meditation and prayer, with others or in private, lead to connection and wholeness. Faith reveals that things are better, and will be better, than they seem.

When families are in crisis because of their troubled child, parents tell me they depend on faith, even parents who don’t profess a faith practice. They say it’s their only source of strength. Most families with a child who is sick, disabled, or mentally ill will go through dark times, when a parent’s world is simply too overwhelming. Most often, no answers are forthcoming, nor any rescue. The only choice is to hand over their burden to a “higher power,” God, the Buddha, Allah, the Great Spirit… This act of “handing over” is a foundation of healing in Alcoholics Anonymous, Narcotics Anonymous, and dialectical behavioral therapy (DBT).

Few things help a family more than a supportive community of believers.  There will be one person who listens to a frightened parent on the phone, and another person who takes a traumatized sibling on an outing, and another person who provides hugs and cookies. If a mentally ill child continues to decline, a good faith-based support network will stay on. The child may not thrive, but the family does, and has the strength and forbearance to handle the years’ long task of supporting their mentally ill loved one.

Science shows that faith results in better lifetime outcomes for a child

This writer typically trusts science, but in the depths of my family’s despair, only faith and the prayers of others kept me from falling apart.

There are scientists among the faithful who have asked the question: does faith really help the mentally ill? In another blog post, Spirituality and mental health, some research are summaries of research going back 36 years.  (Follow this link for the research citations.)  The answer?  Yes, faith makes a real and measurable difference in improving mental health.

More recent scientific research shows clear evidence from brain scans that meditation and prayer change brain electrical activity, from anxious or agitated to serene and grounded.  The person actually feels and behaves better.  This article has more information on this, Yoga – Safe and effective for depression and anxiety.

Like prayer, “talk therapy” or psychotherapy also shows improvement on brain scans. Imagine, just talking with someone improves the physical brain. According to the article appended below, “When God Is Part of Therapy,” many prefer therapists who respect and encourage their faith. It just makes sense.

When faith harms

This section is a personal appeal to faith communities who have unconscionably failed families and their children with mental disorders.

Faith communities depend on people, and people have biases and foibles.  Many of ‘the faithful’ hold negative beliefs about others, right or wrong.  Children who suffer, and their families, are identified as possessed, of evil character, disbelievers, victims of abuse, or cruelest:  those who are paying for their sins. Families are repeatedly told these very things today.

“Sometimes, people hide from the Bible. That is, they use the Christian holy book as an authority and excuse for biases that have nothing to do with God.”
–Leonard Pitts Jr., Miami Herald

Stigmatization from a faith community is a cruel betrayal.

A child’s inappropriate behavior is not a choice, it is a verifiable medical illness, one with a higher mortality rate than cancer:  Mental illness more deadly than cancer for teens, young adults.  Families with sick children need support; our sense of loss is devastating.

Testimonials

Mother with five children, one with bipolar disorder:

“We were members of our church since we were first married, all our daughters grew up here, but when my youngest spiraled down, I was told the sins of the father are visited on the sons. Or we weren’t praying enough. I knew they thought (Dad) had done something bad to her. We left and went church shopping until we found a pastor who understood and supported us.”

Mother of two children, one with acute pervasive development disorder:

“I wish we had a “special needs” church. We’re so afraid our kid is going to say something and we’re not going to be accepted. We haven’t gone to church for years because of this. They just turned their backs on us, it happened to another family with a deaf child. They avoid parents in pain. Deep down in my heart I believe in the Lord, but there are days when I wonder “where is God?” People call out to pray for a job, or a kid’s grades, but we wouldn’t dare ask for us, no one would get it, we’d be told we were bad parents or didn’t punish him enough.”

Mother of two children, one with schizoaffective disorder:

“When I went up to the front to light a candle and ask for a prayer for my daughter, I expected people would come up afterward and give a hug or something, just like with other families with cancer and such. But it didn’t happen. No one even looked at me. I left alone and decided never to go back.”

Some good news

FaithNet

The National Alliance on Mental Illness (NAMI) has recognized the need for the mentally ill to be part of faith communities, and the negative experiences most face when they attempt to participate in a religious community. NAMI started FaithNet to encourage and equip NAMI members to engage with and share their story and NAMI resources with local faith groups, and appeal for their acceptance.

Key Ministry

Key Ministry: Welcoming Youth and Their Families at Church
Stephen Grcevich, M.D., president, Key Ministry and child & adolescent psychiatry in private practice, Chagrin Falls, Ohio

“Key Ministry believes it is not okay for youth living with mental illness and their families to face barriers to participation in worship services, educational programming and service opportunities available through local churches.”

Churches in American culture lack understanding of the causes and the needs of families impacted by mental illness, which poses a significant barrier to full inclusion.

“A study published recently by investigators at Baylor University examined the relationship between mental illness and family stressors, strengths and faith practices among nearly 5,900 adults in 24 churches representing four Protestant denominations. The presence of mental illness in a family member has a significant negative impact on both church attendance and the frequency of engagement in spiritual practices.” When asked what help the church could offer these families, they ranked “support for mental illness” 2nd out of 47 possibilities. Among unaffected families, support for mental illness ranked 42nd.

________________________________________

When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.

When children are hospitalized with other ailments, the family draws sympathy and support from others.  But because of mental health stigma, most families like ours don’t when our child is hospitalized.  If not blame, we are second-guessed, or as bad, met with silence or a change of subject.

ADHD kids become troubled adults

ADHD kids become troubled adults

I confess I used to think attention deficit disorders were not as serious as other disorders.  I was so wrong.

Sure, teens with attention deficits had problems, but they didn’t compare with the disabling and dangerous problems resulting from bipolar or schizophrenia.  ADHD kids seemed more ‘functional’ to me and treatments seemed to work better.  They were also friendly and funny.  While other families with mentally ill children talked about psychotic breaks, suicide, and panic attacks, I heard parents of ADHD kids talk about frustration and daily calls from school.  Heck, kids with ADHD could attend school!

“Genius by birth; slacker by choice.”
–seen on a T-shirt

I confess, I thought ADHD symptoms made a person interesting, and fun and creative (true), but my perception changed radically when I found research on children with ADHD who were tracked from childhood to adulthood.  These studies revealed deeply unsettling news—the consequences of ADHD can be quite serious.

outcomes of ADD and ADHD
Barkley, RA “Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment,” 1998.

Adults with ADHD have a higher risk of developing other psychiatric problems, being victimized and incarcerated, and facing lifetime struggles with education, employment, and relationships.  Summaries from 10 research studies on the long-term prognosis of ADHD are found at the end of this post.

People with ADD and ADHD have so many gifts!

When I attended a children’s mental health conference, a workshop was lead by a panel of young people with with ADHD.  They were articulate about their experiences and needs, answered questions, and interacted appropriately with audiences.  So many strengths!  Young people with other disorders can be challenged by the cognitive and emotional demands of these tasks.  I learned a lot.

Parents need the support to address the basics:  behavior at school and home, school attendance and educational attainment, self-esteem, and self-actualization.  In addition to medical/medication treatment as recommended, parents need to know how to teach self-calming skills so their child can effectively control impulses.

Check out this article:  “Understanding and supporting a child with ADD or ADHD.”

Little things start adding up – Without skills (and/or medication), a person with ADHD slips up on life’s daily little challenges–losing, forgetting, neglecting, overreacting, disappointing others, and undermining themselves in a thousand different ways.

Dependence and resentment – I’ve noticed that those with ADHD seem to find or attract others they can depend on to help them function, but their “caretakers” (spouse, friend, co-worker) and family pay a price.  A person with ADHD can resent their dependence on others, or become so dependent that others resent them.
 
Unfinished business – Those with ADHD drag unfinished projects with them indefinitely, keeping them in an actual or metaphorical garage full of costly unfinished projects.  Little repairs become big expensive repairs through lack of maintenance.  Bills don’t get paid, licenses don’t get renewed, debtors get away with never paying them back.
 
Guide your child to his or her gifts
From personal experience with ADHD children and adults, I know they can love, be affectionate, funny, generous, highly creative, and show empathy for others.
Think of careers your child or teen might pursue that require creativity, energy, and enthusiasm.  Introduce them to experiences that challenge them, and ignore the myth that they can’t focus or that they mess things up, not true.  ADHD kids readily focus on projects they enjoy, demonstrate mental nimbleness with complexities, multitask with accuracy, and shine in emergencies, whether debugging software, making music, or even doing surgery.
Q:  “How many kids with ADHD does it take to change a lightbulb?”
A:  “What was the question again? I saw something shiny.”

ADHD Child T-shirtA personal rant:  I’ve read articles that question the existence of ADHD or criticize parents who get medication for their son or daughter.  Prejudice against this disorder and parents is sadly common. Public misinformation and controversy over ADHD and medication negatively influences parents’ decisions.

Some think ADHD is an excuse for bad parenting, or treatable with natural substances or meditation, etc.  Parents don’t cause ADD, ADHD.  And while non-drug options help, results can be marginal and short-lived.  I know parents who cling to pseudo-treatments that fit a personal philosophy, but can’t admit when they’re child’s symptoms aren’t improving. If a non-drug remedy is effective, this will be the proof: the child keeps up with their peers at school, exhibits behaviors typical for their age, and is able to learn some self-control.

At another extreme, some parents want a “quick fix” with pills. Or, if parents are happy with the results of the right medication, they overlook their child’s discomfort with side effects, or worse, they overlook how their home environment aggravates distraction and chaos. A pill will partially compensate for bad parenting and a crazy-making household, but that child does not deserve the burden.


High School Students With ADHD: The Group Most Likely to…Fizzle

 Breslau J, Miller E, Joanie Chung WJ, Schweitzer JB.Childhood and adolescent onset psychiatric disorders, substance use, and failure to graduate high school on time. Journal of Psychiatric Research.  Jul 15 2010

 Adolescents with attention deficit/hyperactivity disorder (ADHD), conduct disorder, or who smoke cigarettes are least likely to finish high school (HS) on time or most likely to drop out altogether, researchers at the University of California, Davis, School of Medicine (UC Davis) have found.

Lead investigator Joshua Breslau, PhD, ScD, medical anthropologist and psychiatric epidemiologist reported that of a total of 29,662 respondents, about one-third (32.3%) of students with combined-type ADHD were more likely to drop out of high school than students with other psychiatric disorders. This figure was twice that of teens with no reported mental health problems (15%) who did not graduate. Students with conduct disorder were the second at-risk group (31%) to drop out or not finish on time. Cigarette smokers were third in line, with a staggering 29% who did not finish high school in a timely manner.

Educational achievement squelched in children with ADHD
Newsletter – NYU Child Study Center, New York, NY, February 2009
Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common disorders in childhood and adolescence, with prevalence estimates ranging from five to ten percent.  Children with untreated ADHD drop out of high school 10 times more often than other children.

Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder
American Journal of Psychiatry, January 2010
Researchers studied age 6 to 18-year-old girls with diagnosed ADHD and followed up after 11 years.  Conclusions:  By young adulthood, girls with ADHD were at high risk for antisocial, addictive, mood, anxiety, and eating disorders. However, ADHD medications appear to reduce the prevalence of multiple disorders at least in the short-term.  These findings, also documented in boys with ADHD, provide further evidence for negative long-term impacts ADHD across the life cycle.

Brain abnormality found in boys with attention deficit hyperactivity disorder
Journal of Abnormal Psychology, March 2009
Researchers trying to uncover the mechanisms that cause ADHD and conduct disorder found an abnormality in the brains of adolescent boys suffering from the conditions. The research focused on two brain areas, the “mid brain” striatal, and cerebral cortex.  The mid brain motivates people to engage in pleasurable or rewarding behavior.  The cortex notices if an expected reward stops and considers options. However, this doesn’t occur as quickly in boys with ADHD or conduct disorders.  Instead, the mid brain region keeps trying for rewards, which is a quality of addictive behavior.

Kids with ADHD more likely to bully, and those pushed around tend to exhibit attention problems
Developmental Medicine & Child Neurology, February 2008
Children with attention deficit hyperactivity disorder are almost four times as likely as others to be bullies. And, in an intriguing corollary, the children with ADHD symptoms were almost 10 times as likely as others to have been regular targets of bullies prior to the onset of those symptoms.  Bullies were the kids in class who couldn’t sit still and listen, didn’t do their homework and were almost constantly in motion.  Children with ADHD symptoms make life miserable for their fellow students, and they too can develop attention problems related to the stress of being bullied.

Girls’ hyperactivity and physical aggression during childhood and adjustment problems in early adulthood:  A 15-year longitudinal study.
Archives of General Psychiatry, March 2008
Girls with hyperactive behavior such as restlessness, jumping up and down, and difficulty keeping still or fidgety, and girls exhibiting physical aggression such as fighting, bullying, kicking, biting or hitting, all signs of ADHD, were found to have a high risk of developing adjustment problems in adulthood.

Teen’s inattentive symptoms may determine how long they stay in school
Forum for Health Economic & Policy, November 2009
Poor mental health of children and teenagers has a large impact on the length of time they will stay in school, based on the fact that at conception there are differences in genetic inheritance among siblings. This study provides strong evidence that inattentive symptoms of ADHD in childhood and depression in adolescents are linked to the number of years of completed schooling.

Children with ADHD more likely to participate in crimes
Yale School of Public Health and University of Wisconsin at Madison, October 2009
Children with ADHD are more likely to participate in crimes such as burglary, theft and drug dealing as adults.  Those who had attention deficit hyperactivity disorder as children were at increased risk of developing criminal behaviors.  Researchers said one reason is that children with ADHD tend to have lower amounts of schooling.

ADHD may affect adults’ occupational and educational attainments
Journal of Clinical Psychiatry September 2008
Adults who have ADHD generally have lower occupational and educational attainments as adults than they might have reached if they didn’t have the disorder, at least compared to what attainments would have been expected given their intellect.  “Educational and occupational deficits… are a consequence of ADHD and not IQ,” lead researchers Dr. Joseph Biederman said. The finding strongly underscores the need for “diagnosing and treating ADHD to avert these serious consequences,” he said.

Attention-deficit/hyperactivity disorder (ADHD) in the course of life.
European Archives of Psychiatry and Clinical Neuroscience, September 2006.
ADHD is a pervasive disorder that extensively impairs  quality of life and that can lead to serious secondary problems.  Long-term studies have demonstrated that the disorder is not limited to childhood and adolescence. The clinical experience indicates substantial difficulties for adults whose ADHD is not diagnosed and treated, and they often create extensive costs for the welfare system. The evidence-based psychiatric treatment available is highly effective and inexpensive.

70% of crystal meth (methamphetamine) inpatients had ADHD
Journal of  Addiction Disorders. 2005, and the blog: Adult ADHD Strengths.
Methamphetamine-dependent inpatients were screened for childhood attention deficit hyperactivity disorder (ADHD), and of the participants, 70.6% screened positive for ADHD and reported significantly more frequent methamphetamine use prior to baseline.  ADHD participants exhibited significantly worse psychiatric symptomatology.  At a three-week follow-up, all who didn’t complete treatment screened positive for ADHD.

Spirituality and mental health, some research

Spirituality and mental health, some research

Scientists worldwide have been studying the effect of religion and spirituality on mental health and addiction recovery in children, teens, and adults.  Below are research findings that show religion and spirituality improve adult and adolescent mental health, including recovery from mental crises and substance abuse, when the spiritual approach carries messages of love, kindness, tolerance, and moral responsibility.  But when religion had a punitive or unforgiving message to those with mental or substance abuse disorders, the results were disheartening: a worsening of psychotic symptoms; inability to sustain recovery from substance abuse; and physical abuse.

If you look at the dates of some of these studies, you’ll see that researchers have been measuring of the value of spirituality for mental health and addiction for ~30 years, and results have consistently shown statistically significant positive benefits.

Below are summaries research reports–clinical writing that can be difficult to wade through if you’re not a mental health geek, so key findings and conclusions are highlighted in brown to make it easier to scan.

–Margaret

A second article in this blog documents both positive and negative effects of parents’ experiences in a religious community, Faith can help, & harm, a family’s mental health.


God Imagery and Treatment Outcomes Examined
Currier JM, Foster JD, Abernathy AD, et al. God imagery and affective outcomes in a spiritually integrative inpatient program. [Published online ahead of print May 5, 2017]. Psychiatry Res. doi:10.1016/j.psychres.2017.05.003.

Patients’ ability to derive comfort from their religious faith and/or spirituality emerged as a salient mediating pathway between their God imagery at the start of treatment and positive affect at discharge, a recent study found. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually-integrative inpatient program over a 2-year period, researchers tested direct and indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes.

Findings  —  Analyses revealed that patients generally experienced reductions in negative emotion in God imagery over the course of their admissions.


When God Is Part of Therapy
Tara Parker Pope, March 2011, New York Times

Faith-based therapy is growing in popularity, reports Psychology Today, as more patients look for counselors who can discuss their problems and goals from a religious frame of reference.

Studies show that people prefer counselors who share their religious beliefs and support, rather than challenge, their faith. Religious people often complain that secular therapists see their faith as a problem or a symptom, rather than as a conviction to be respected and incorporated into the therapeutic dialogue, a concern that is especially pronounced among the elderly and twenty-somethings. According to a nationwide survey by the American Association of Pastoral Counselors (AAPC), 83 percent of Americans believe their spiritual faith and religious beliefs are closely tied to their state of mental and emotional health. Three-fourths say it’s important for them to see a professional counselor who integrates their values and beliefs into the counseling process.

The problem for many patients in therapy is that many patients are far more religious than their therapists.

Nearly three-fourths of Americans say their whole approach to life is based on religion. But only 32 percent of psychiatrists, 33 percent of clinical psychologists and 46 percent of clinical social workers feel the same. The majority of traditional counselor training programs have no courses dealing with spiritual matters.


“[Spirituality] enables neurotic conflicts typical for adolescence to be more easily overcome.”

The influence of religious moral beliefs on adolescents’ mental stability.
Pajević I, Hasanović M, Delić A., : Psychiatry Danub. 2007 Sep;19(3):173-83

University Clinical Centre Tuzla, Trnovac b.b, 75 000 Tuzla, Bosnia & Herzegovina. zikjri@bih.net.ba.
This study included 240 mentally and physically healthy male and female adolescents attending a high school, who were divided into groups equalized by gender (male and female), age (younger 15, older 18 years); school achievement (very good, average student); behaviour (excellent, average); family structure (complete family with satisfactory family relations), and level of exposure to psycho-social stress (they were not exposed to specific traumatizing events).  Subjects were assessed with regard to the level of belief in some basic ethical principles that arise from religious moral values.

Conclusions — A higher index of religious moral beliefs in adolescents enables better control of impulses, providing better mental health stability.  It enables neurotic conflicts typical for adolescence to be more easily overcome.  It also causes healthier reactions to external stimuli.  A higher index of religious moral beliefs of young people provides a healthier and more efficient mechanism of anger control and aggression control.  It enables transformation of that psychical energy into neutral energy which supports the growth and development of personality, which is expressed through socially acceptable behaviour.  In this way, it helps growth, development and socialization of the personality, leading to the improvement in mental health.


Religion, Stress, and Mental Health in Adolescence: Findings from Add Health
Nooney, J. G. 2008-10-23 from http://www.allacademic.com/meta/p106431_index.html

A growing body of multidisciplinary research documents the associations between religious involvement and mental health outcomes, yet the causal mechanisms linking them are not well understood.  Ellison and his colleagues (2001) tested the life stress paradigm linking religious involvement to adult well-being and distress.  This study looked at adolescents, a particularly understudied group in religious research. Analysis of data from the National Longitudinal Study of Adolescent Health (Add Health) reveals that religious effects on adolescent mental health are complex.  While religious involvement did not appear to prevent the occurrence of stressors or buffer their impact, some support was found for the hypothesis that religion facilitates coping by enhancing social and psychological resources.


Study Links Religion and Mental Health
David H. Rosmarin and Kenneth Pargament, Bowling Green State University, Ohio, (IsraelNN.com) 2008

A series of research studies – known as the JPSYCH program – reveals that traditional religious beliefs and practices are protective against anxiety and depression among Jews.  The research indicates that frequency of prayer, synagogue attendance, and religious study, and positive beliefs about the Divine are associated with markedly decreased levels of anxiety and with higher levels of happiness.  “In this day and age, there is a lot to worry about,” Rosmarin notes, “and the practice of religion may help people to maintain equanimity and perspective.”


The Once-Forgotten Factor in Psychiatry: Research Findings on Religious Commitment and Mental Health (excerpt)
David B. Larson, M.D., M.S.P.H., Susan S. Larson, M.A.T., and Harold G. Koenig, M.D., M.H.Sc., Psychiatric Times.  Vol. 17 No. 10, October 1, 2000

“The data from many of the studies conducted to date are both sufficiently robust and tantalizing to warrant continued and expanded clinical investigations.”

Treatment of Drug Abuse

  • The lack of religious/spiritual commitment stands out as a risk factor for drug abuse, according to past reviews of published studies.  Benson (1992) reviewed nearly 40 studies documenting that people with stronger religious commitment are less likely to become involved in substance abuse.
  • Gorsuch and Butler (1976) found that lack of religious commitment was a predictor of drug abuse.  The researchers wrote:  “Whenever religion is used in analysis, it predicts those who have not used an illicit drug regardless of whether the religious variable is defined in terms of membership, active participation, religious upbringing or the meaningfulness of religion as viewed by the person himself.”
  • Lorch and Hughes (1985), as cited by the National Institute for Healthcare Research (1999), surveyed almost 14,000 youths and found that the analysis of six measures of religious commitment and eight measures of substance abuse revealed religious commitment was linked with less drug abuse.  The measure of “importance of religion” was the best predictor in indicating lack of substance abuse.  The authors stated, “This implies that the controls operating here are deeply internalized values and norms rather than fear or peer pressure.”
  • Developing and drawing upon spiritual resources can also make a difference in improving drug treatment.  For instance, 45% of participants in a religious treatment program for opium addiction were still drug-free one year later, compared to only 5% of participants in a nonreligious public health service hospital treatment program-a nine-fold difference(Desmond and Maddux, 1981).
  • Confirming other studies showing reduced depression and substance abuse, a study of 1,900 female twins found significantly lower rates of major depression, smoking and alcohol abuse among those who were more religious (Kendler et al., 1997).  Since these twins had similar genetic makeup, the potential effects of nurture versus nature stood out more clearly.

“lack of religious commitment was a predictor of drug abuse”

Treatment of Alcohol Abuse

  • Religious/spiritual commitment predicts fewer problems with alcohol (Hardesty and Kirby, 1995).  People lacking a strong religious commitment are more at risk to abuse alcohol (Gartner et al., 1991).  Religious involvement tends to be low among people diagnosed for substance abuse treatment (Brizer, 1993).
  • A study of the religious lives of alcoholics found that 89% of alcoholics had lost interest in religion during their teen-age years, whereas 48% among the community control group had increased interest in religion, and 32% had remained unchanged (Larson and Wilson, 1980).
  • A relationship between religious or spiritual commitment and the non-use or moderate use of alcohol has been documented.  Amoateng and Bahr (1986) reported that, whether or not a religious tradition specifically proscribes alcohol use, those who are active in a religious group consumed substantially less alcohol than those who are not active.
  • Religion or spirituality is also often a strong force in [addiction] recovery.  Alcoholics Anonymous (AA) invokes a Higher Power to help alcoholics recover from addiction.  Those who participate in AA are more likely to remain abstinent after inpatient or outpatient treatmen t(Montgomery et al., 1995).

“…adolescents [who were] frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory.”

Suicide Prevention – Surging suicide rates plague the United States, especially among adolescents.  One in seven deaths among those 15 to 19 years of age results from suicide.

  • One study of 525 adolescents found that religious commitment significantly reduced risk of suicide (Stein et al., 1992).
  • A study of adolescents found that frequent church-goers with high spiritual support had the lowest scores on the Beck Depression Inventory (Wright et al., 1993).  High school students of either gender who attended church infrequently and had low spiritual support had the highest rates of depression, often at clinically significant levels.
  • How significantly might religious commitment prevent suicide?  One early large-scale study found that people who did not attend church were four times more likely to kill themselves than were frequent church-goers (Comstock and Partridge, 1972).  Stack (1983) found rates of church attendance predicted suicide rates more effectively than any other evaluated factor, including unemployment.  He proposed several ways in which religion might help prevent suicide, including enhancing self-esteem through a belief that one is loved by God and improving moral accountability, which reduces the appeal of potentially self-destructive behavior.
  • Many psychiatric inpatients indicate that spiritual/religious beliefs and practices help them to cope. Lindgren and Coursey (1995) reported 83% of psychiatric patients felt that spiritual belief had a positive impact on their illness through the comfort it provided and the feelings of being cared for and not being alone it engendered.

Potential Harmful Effects

Psychiatry still needs more research and clearer hypotheses in differentiating between the supportive use of religion/spirituality in finding hope, meaning, and a sense of being valued and loved versus harmful beliefs that may manipulate or condemn.”

  • Alcoholics often report negative experiences with religion and hold concepts of God that are punitive, rather than loving and forgiving (Gorsuch, 1993).
  • Bowman (1989).  In assessing multiple personality disorder, children in rigid religious families, whose harsh parenting practices border on abuse, harbor negative images of God.  Josephson (1993). Individual psychopathology is linked with families whose enmeshment, rigidity and emotional harshness were supported by enlisting spiritual precepts.
  • Sheehan and Kroll (1990).  Of 52 seriously mentally ill hospitalized patients diagnosed with major depression, schizophrenia, manic episode, personality disorder and anxiety disorder, almost one-fourth of [psychiatric patients] believed their sinful thoughts or acts may have contributed to the development of their illness.  Without the psychiatrist inquiring about potential religious concerns, these beliefs would remain unaddressed, potentially hindering treatment until discovered and resolved.  Collaboration with hospital chaplains or clergy may help in some of these instances of spiritual problems or distress.

Conclusion

Religious/spiritual commitment may enhance recovery from depression, serious mental or physical illness, and substance abuse; help curtail suicide; and reduce health risks.  More longitudinal research with better multidimensional measures will help further clarify the roles of these factors and how they are beneficial or harmful.

–Margaret